Summary & Overview
CPT 63075: Cervical Disc Herniation Decompression with Graft
CPT code 63075 denotes a cervical spine surgical procedure performed to remove herniated disc material with placement of a graft to restore disc space and decompress affected nerve roots or the spinal cord. This procedure is a common definitive intervention for cervical radiculopathy or myelopathy when conservative care fails and has important implications for surgical volume, hospital resource utilization, and payer coverage policies nationwide.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical context for the procedure, an explanation of typical sites of service (hospital inpatient and outpatient surgical centers), and the operational elements that influence billing and authorization, such as indications for surgery and the role of grafts in fusion procedures.
The publication summarizes benchmarks and coverage considerations relevant to payers listed above, highlights policy updates affecting surgical spine care, and outlines the procedural coding scope for billing teams and revenue cycle stakeholders. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 63075 describes a surgical procedure to decompress nerve roots and/or the spinal cord by removing herniated portions of a cervical intervertebral disc and placing graft material to fill the resulting disc space. The procedure addresses symptomatic cervical disc herniation when conservative treatments such as medication have failed and the herniated nucleus pulposus is causing nerve root or spinal cord compression and pain.
Service type: Surgical decompression with interbody grafting for cervical disc herniation.
Typical site of service: Hospital inpatient or outpatient surgical center depending on clinical complexity and surgeon preference.
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents with progressive right-sided neck pain radiating into the right upper extremity with numbness and weakness in the C6 distribution despite optimized conservative care including physical therapy, oral analgesics, and epidural steroid injection over 6–12 weeks. MRI of the cervical spine demonstrates a right paracentral herniated nucleus pulposus at C5–C6 causing compression of the exiting C6 nerve root and correlating with exam findings of decreased biceps reflex and wrist extensor weakness. The patient is scheduled for anterior cervical discectomy and fusion with removal of the herniated disc material and placement of an interbody graft.
The clinical workflow includes preoperative evaluation by the spine surgeon and anesthesia, preauthorization and documentation of medical necessity, perioperative antibiotics and anesthesia in an operating room or hospital outpatient department, surgical decompression of the nerve root with discectomy and interbody grafting, intraoperative neurophysiologic monitoring as indicated, postoperative recovery in PACU, and routine follow-up with imaging and neurological assessment. Typical site of service is an acute care hospital operating room or hospital outpatient surgery center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified | Rarely used; placeholder if no other modifier applies (use sparingly) |